Labour’s NHS manifesto not ‘Fit for the Future’

The recovery of the NHS is in the hands of the incoming government and the balance of forces able to force change. Keep Our NHS Public’s crucial concerns in the Labour Manifesto on the NHS are:

▪︎No commitment to invest the required funds in the public NHS after 14 years of austerity – every chance finances will be squeezed further
▪︎Insistence that government must prioritise thoroughgoing NHS reforms over funding
▪︎No commitment to ending the wasteful and damaging investment in the private sector invited into the NHS body and parasitising it
▪︎Insistence that there is ‘spare capacity’ in the private sector that can benefit the NHS and end waiting lists, when all the evidence shows exactly the reverse is true
▪︎No commitment to pay restoration for NHS staff and a reliance on their agreeing to work overtime to reduce the NHS waiting lists
▪︎No commitment to ending the charging of undocumented people for healthcare
▪︎It is simply not true that Labour’s plans are ‘in line with the principles of the NHS that Labour founded’

It is inevitable now that the government to be elected on 4 July 2024 will be Labour, so Labour’s manifesto on the NHS (‘Build an NHS Fit For the Future’ pp91-103) is of particular importance. (A critique of other parties’ manifesto is here.) 

Labour’s promises

Labour says: ‘Labour will stop the chaos in our health and care services, turn the page, and reform them in line with the principles of the NHS that Labour founded.’ (Manifesto p103)

We say: Labour’s plans overturn several founding principles of the NHS, which are: a national health service that is publicly provided and publicly accountable, as well as universal, comprehensive, and free at the point of use. Labour’s Manifesto embraces the private sector, despite the damage it has already done, and continues the Tory fragmentation of our NHS. It does nothing to overturn the Hostile Environment and restore free treatment for everyone in Britain, another founding principle. Immediately, the NHS needs stability and urgent funding, not “reform” and further disorganisation. NHS staff and services need security to do their job and to treat patients safely and well. Primary and community care, hospitals and public health desperately need urgent support. To restore the public NHS, the government needs to bring forward new legislation to undo the damage of the 2012 and 2022 Health acts.

On commitment to the NHS model

Labour says: ‘The best health services should be available, free for all. Money should no longer be the passport to the best treatment. People should get the best that modern science can offer. The NHS will always be publicly owned and publicly funded.’ (p93)

We say: Labour does not say the NHS will be publicly provided, a key founding principle. Labour’s silence on this speaks volumes. Whole sections of NHS provision, management and planning are being contracted out – not ‘sold off’. These contracts cause long-term damage to NHS services, which are critically losing NHS staff and NHS funding to the private sector.

The NHS needs ‘fundamental reform’

Labour says: ‘Labour’s mission is to build an NHS fit for the future. Investment alone won’t be enough to tackle the problems facing the NHS; it must go hand in hand with fundamental reform.’ (p93)

We say: The NHS model does not need reform, it needs restoring. It is the successive re-disorganisations and policies undermining the NHS for decades that must go.

The NHS, when funded to meet need, not defunded for ideological reasons, has been and can be again one of the best health systems in the world.

The NHS needs urgent funding – there is a shortfall of £40bn a year compared to France. Investing in scanners, IT systems and other technology is very different from ‘fundamental reform’. It is merely giving NHS staff the tools they need and the support they deserve. Of course ‘investment alone’ is not sufficient: alongside investment in the public NHS must be the missing commitment to publicly provided healthcare.

‘Not just a sickness service’ (p93)

Labour says: ‘We must change the NHS so that it becomes not just a sickness service, but able to prevent ill heath in the first place.’
‘And we will embed a greater focus on prevention throughout the entire healthcare system and supporting services.’

We say: We have to rebuild a coherent and comprehensive public health service and tackle health inequalities, alongside the rebuilding of primary, community and hospital care.  

The Conservative government defunded, fragmented and weakened public health services which have been an essential part of the NHS since 1948. The consequences were seen in the Covid pandemic. They have heightened poverty and inequality, worsened health inequality and undermined the NHS. These have to be addressed.

Community-based care: ‘Healthcare closer to home’

Labour says: ‘Labour’s reforms will shift our NHS away from a model geared towards late diagnosis and treatment, to a model where more services are delivered in local communities.’ (p92)
‘The National Health Service needs to move to a Neighbourhood Health Service, with more care delivered in local communities to spot problems earlier.’ (p98)

We say: A comprehensive and safe NHS absolutely needs well-funded hospitals in partnership with well-staffed, properly paid and clinically trained community, GP and mental health services. Community services must be able to rely on hospital back up when needed. When that is achieved, we can truly talk about safe community-based care. Without a cast-iron commitment to build back the capacity of hospitals and the resources of GP and primary care, ‘care in the community’ will be used as a smokescreen for refusing to invest in hospitals.

Reliance on big tech and AI

Labour says: ‘We will harness the power of technologies like AI to transform the speed and accuracy of diagnostic services, saving potentially thousands of lives.’ (p94)

We say: Labour is silent on the risks of increasing reliance on technology, much of which is controlled by global corporations. What happens when computers crash, or data is hacked, or new diseases emerge? We reject the policy assumption that the ‘solution’ to NHS capacity is technology. The quality, safety and effectiveness of the NHS is founded primarily on its staff. Human interaction in clinical decision-making must not be further marginalised, with worrying implications for patients and staff. AI and data systems must serve the needs of patients and staff, not the monetising intentions of major tech and data corporations at the expense of NHS skilled staff. Management of our data by the NHS should be founded on public trust. Data must not be exploited for profit.

Waiting list and NHS staff

Labour says: ‘We will deliver an extra two million NHS operations, scans, and appointments every year; that is 40,000 more appointments every week. We will do this by incentivising staff to carry out additional appointments out of hours.’ (p95)

We say: There are 1.6 million interactions with patients in the NHS daily. Labour is relying on an extra 8000 appointments per day –0.5% of daily NHS activity in comparison. And without a commitment to pay justice for NHS staff, it is expecting a burnt out and exhausted workforce to work extra evenings and weekends. This is not an acceptable strategy. The NHS will solve the waiting list crisis if staff numbers are built back, if staff are paid fairly and if the NHS is invested in. The priority is to build back respect for NHS and care staff and halt the haemorrhaging of workforce away from the NHS.

Waiting lists and ‘spare capacity’

Labour says: ‘Labour will use spare capacity in the independent sector to ensure patients are diagnosed and treated more quickly.’ (p95

We say: There truly is no spare capacity in the private sector that would not further undermine the NHS. Private healthcare relies on more doctors, nurses and technicians taken from the NHS, and the diversion of NHS funding to profit-taking companies. Very clear evidence of the negative impact is the impact on NHS ophthalmology. The rapid expansion of private provision of NHS cataract surgery from 24% to 60% in five years isundermining the funding of NHS eye departments – patients with serious conditions are going blind on waiting lists. In the 2000s, it was the growth of NHS capacity that solved the waiting lists inherited from the Tory Government, not the disruptive, ineffective, and heavily subsidised independent sector treatment centres imposed on the NHS

Workforce planning

Labour says: ‘We will deliver the NHS long-term workforce plan to train the staff we need to get patients seen on time…’ (p96)

We say: The NHS long-term workforce plan must be fully funded. But the current plan will replace trained doctors and nurses in hospital and primary care with the planned 10,000 ‘Physician Associates’ (PAs) and 2,000 ‘Anaesthesia Associates’, along with many thousands of ‘Nursing Associates’. Surgical Care Practitioners, another group without full clinical training, are now doing surgical operations for which they are not qualified. PAs are now prescribing and taking on-call duties, dangerously beyond their role in supporting trained doctors. 1000s of newly qualified GPs are now finding there may be no job for them to take up and training opportunities given to PAs instead.

NHS strikes

Labour says: … Too many patients have seen their treatment affected by strikes.’ (p96)

We say: The new government must address the causes of the NHS strikes – loss of pay, covering 120,000 vacancies, insufficient staff, lack of respect despite the dedication shown during Covid. There must be pay justice and improved work conditions to repair morale and retain nurse, junior doctors and all NHS staff

Primary care

Labour says: ‘Labour will also take the pressure off GP surgeries, by improving access to services and treatment through new routes. We will create a Community Pharmacist Prescribing Service, granting more pharmacists independent prescribing rights.’ (98)

We say: Where is the commitment to more GPs? It is widely accepted that there are over 4200 vacancies expected to grow to 8800 by 2031. There are 1800 fewer GPs today than in 2015. The Labour Manifesto does not mention the Longterm Workforce Plan intention to develop 10,000 non-doctor ‘Physician Associates’, nor that they are being used to replace rather than support GPs, and that there are 1000s of GP trainees at the end of their training now unemployed qualified GPs. The new government must urgently reverse the decision to put the GMC (doctors’ regulatory body) in charge of regulating non-doctor Medical Associate Professions (MAPs, including Physician Associates). It must immediately reverse the block on expanding GP numbers.

Dentistry

Labour says: ‘To rebuild dentistry for the long term, Labour will reform the dental contract, with a shift to focusing on prevention and the retention of NHS dentists.’ (p99)

We say: We welcome the commitment to restore NHS dentistry and retain dentists. But it is urgent that more dentists, dental nurses and hygienists are trained and existing dental staff are retained. A new contract should support dentists to provide a full range of treatments on the NHS and be patient-focused and preventive. The contract should be payment per numbers of patients, and charging must be abolished. Dentists should be co-located with General Practitioners in neighbourhood health centres where the staff work as public servants for a public service

Covid and technology

Labour says: ‘The Covid-19 pandemic showed how a strong mission-driven industrial strategy, involving government partnering with industry and academia, could turn the tide on a pandemic. This is the approach we will take in government.’ (p96)

We say: The overriding lesson from the pandemic was that an undermined NHS and public health service, by-passed by a politically incompetent and corrupt government, led to tens of 1000s of avoidable deaths. This was Misconduct in Public Office.

How can Labour fail to mention here the money wasted on failed PPE contracts and an expensive private Test & Trace system which did not work. These partnerships with industry did not turn the tide on the pandemic. NHS staff risked their lives and thousands died doing so.

Procurement

Labour says: ‘We will develop an NHS innovation and adoption strategy in England. This will include a plan for procurement, giving a clearer route to get products into the NHS, coupled with reformed incentive structures to drive innovation and faster regulatory approval for new technology and medicines.’ (p97)

We say: The NHS Logistics Authority was prepared for privatisation under Labour in the 2000s and dissolved in 2018 to make way for a privatised system under ‘NHS Supply Chain’. This process was responsible for the lethal failures of PPE. Control and management of procurement must be brought back into the NHS. Regulatory approval cannot be rushed or bypassed. The fact that a new product has been tried out at one Trust does not justify a national roll-out without investigating that it is safe, effective, efficient, and suitable for other groups of patients elsewhere in Britain.

Patient empowerment, patient choice, self-referral

Labour says: ‘Labour will therefore transform the NHS app, putting patients in control of their own health to better manage their medicine, appointments, and health needs.’ (p97)

We say: However convenient for many patients a health app may be, it does not put patients ‘in control of their own health’. It does even less for those without smart phones, no access to the internet or disabled people presented with barriers to their engagement.

‘We will allow other professionals, such as opticians, to make direct referrals to specialist services or tests, as well as expanding self-referral routes where appropriate.’ (p99)

We say: Regarding self-referral, we agree with Oxford GP Dr Helen Salisbury writing in the BMJ:
‘Some of [Wes Streeting’s] comments demonstrate a failure to understand the workings of the service over which he’d one day like to preside… To a certain extent this [the referral routes] already occurs… [but] it would make no sense for people to add to waiting lists without any triage or guidance, only to find that they’d sought help from the wrong expert.’

Maternity and patient safety

Labour says: ‘Labour will ensure that trusts failing on maternity care are robustly supported into rapid improvement. We will train thousands more midwives as part of the NHS Workforce Plan and set an explicit target to close the Black and Asian maternal mortality gap.’ (p98)

We say: A commitment to deliver safe maternity care has to be welcomed. But as with the whole restoration required, it will take investment and it will also require a determination to fight inequality and racism across departments of government and the NHS.

And what about patient safety beyond maternity?

We say: There is a national emergency in the NHS. The UK has one of the worst avoidable deaths record of OECD countries, with the USA and Greece – patients who would have survived with appropriate treatment. Over 250 patients are dying every week from delayed emergency care and 39,000 died on cardiac waiting lists in 2022 alone. A national emergency should be called and measures taken to invest and expand NHS capacity.

Governance

Labour says: ‘Labour will implement professional standards and regulate NHS managers, ensuring those who commit serious misconduct can never do so again. And we will establish a Royal College of Clinical Leadership to champion the voice of clinicians.’ (p98)

We say: We want a commitment to restore the NHS along with a primacy of public duty of managers and NHS staff to serve the interests of patients above all.
There are dangers to be avoided in pitting managers against clinicians and clinicians against non-clinical staff. NHS teamwork needs to be rebuilt.

Social Care reforms

Labour says: ‘Labour will undertake a programme of reform to create a National Care Service by national standards, delivering consistency of care across the country. We will enhance partnership working across employers, workers, trade unions and government and establish a Fair Pay Agreement in adult social care.’ (p100)

We say: We must end this social care disgrace. Social care should be free at the point of use, publicly provided, funded and accountable. A national care, support and independent living service is urgent. This important commitment simply must not be delayed over a ten-year period before it takes effect. And the positive change must be based on a process which listens to disabled people, paid and unpaid carers, patient and pensioner groups. The current social care system is predominantly private and major hedge funds are extracting huge profits. This parasitisation of social need must be stopped.  

Mental health and autism and learning disability

Labour says: ‘Across society, mental health has stepped out of the shadows, yet it is difficult to argue the NHS has kept up… And, as a crucial part of that, we will reform the NHS to ensure we give mental health the same attention and focus as physical health’. (p94-5)

‘Labour will bring waiting times down and intervene earlier. We will recruit an additional 8,500 new staff to treat children and adults through our first term…

‘Mental health legislation is also woefully out of date. The treatment of people with autism and learning difficulties is a disgrace. The operation of the Mental Health Act discriminates against Black people who are much more likely to be detained than others. Labour will modernise legislation to give patients greater choice, autonomy, enhanced rights and support, and ensure everyone is treated with dignity and respect throughout treatment.’ (p101-2)

We say: Political leaders have been saying ‘parity of esteem for mental and physical health’ for too long. If these commitments are met, they will be welcomed. To be met, they will need significant investment in NHS hospital and community mental health. And this cannot be at the expense of primary, hospital and public health services, but alongside the restoration of those services.

The investment in, and reliance on, private mental health hospitals and the damaging out of area inpatient admissions must end.

Obesity

Labour says: ‘We face a childhood obesity crisis. So, Labour is committed to banning advertising junk food to children along with the sale of high-caffeine energy drinks to under-16s.’ (p102)

We say: To tackle obesity is to view it through the prism of social and economic inequalities and the health inequalities that flow from these. It requires commitment to tackle the massive conflict of interest of the sugar lobby, food and drink industries.

Health inequalities

Labour says: ‘Labour will tackle the social determinants of health, halving the gap in healthy life expectancy between the richest and poorest regions in England. Never again will women’s health be neglected. Labour will prioritise women’s health as we reform the NHS.’ (p103)

We say: If the social factors affecting health inequalities are to be addressed, a commitment to and investment in social justice and equity is required including:

Equity of access to healthcare for all – including disadvantaged groups

Action to address social inequality, poverty, low pay and unsafe working conditions, food insecurity, poor housing, under-investment in children and young people, discrimination and racism, pollution, and climate change – the overarching causes of health inequality.

NHS charging of undocumented people for their health care

The Labour manifesto contains no commitment to end health charging of migrants, denial of healthcare to undocumented adults and children, or exploitative health surcharges of migrant workers.

We say:
The outgoing Government’s Hostile Environment scapegoats undocumented people for crumbling public services. They use this disgraceful lie to deflect their blame by fuelling racism. Universal access to healthcare free at the point of need has ended – so many migrants are being charged for NHS care. NHS charges for everyone in Britain, including undocumented people, must be abolished immediately

The Labour Manifesto concludes:

‘Labour will stop the chaos in our health and care services, turn the page, and reform them in line with the principles of the NHS that Labour founded.’

We say:
In truth, the founding principles of the NHS have been overturned, and Labour’s embrace of the private sector would have Nye Bevan turning in his grave.

Restore the People’s NHS

The NHS is under unprecedented pressures, people are dying avoidable deaths and the population is suffering: difficulty seeing a GP and targets being missed; over 250 deaths every week caused by delay in assessment and treatment of seriously ill people; over 39,000 dying prematurely on cardiac waiting lists (in 2022 alone); 120,000 vacancies in the NHS and over 150,000 vacancies in the care sector whilst the services are haemorrhaging staff due to low pay, lower morale and staff looking for work elsewhere.

This stark reality means the Government should declare a national health emergency to release emergency measures proportionate to the severity of loss of life, health and livelihood and to build the capacity of the NHS.

It is inevitable now that the government to be elected on 4 July 2024 will be Labour, so Labour’s manifesto on the NHS (‘Build an NHS Fit For the Future’ pp91-103) is of particular importance. (A critique of other parties’ manifesto is here.) Labour may claim that the election is a mandate to carry through their manifesto on health. But there has been no public debate on the detail. We believe that the vote that brings them to office will reflect widespread, deep disaffection with the Conservative Government and does not give Labour a mandate to enforce its woefully inadequate plan for the NHS in its manifesto.

Keep Our NHS Public’s urgent call is to ‘Restore the People’s NHS’
See our detailed vision to back that call.
We will not be ending our vigilance and actions on 5 July: Keep Our NHS Public’s campaign to ‘Restore the People’s NHS’ is needed more than ever.

OUR FIVE DEMANDS
1. A publicly provided NHS: end private involvement
2. An NHS funded to succeed – not defunded to fail
3. Respect, recognition and decent pay & conditions for all health workers
4. Re-invest in public health & tackle health inequalities
5. Rebuild, restore and expand our NHS

OUR FACTSHEETS
See our set of 14 evidenced factsheets here
How to get involved and what you can do here